Ustekinumab treatment of pityriasis rubra pilaris: A report of five cases

Abstract

Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory skin disease of unknown etiology. Patients refractory to conventional therapies have been treated successfully with biologic drugs such as anti-tumor necrosis factor agents. Recently, a role of the interleukin-23/T-helper 17 axis in PRP has been described. Our objective was to assess the effectiveness of ustekinumab in five patients with adult-onset PRP refractory to conventional therapies. In the present study, four patients had type I and one patient type II adult-onset PRP. They were treated with three s.c. doses of ustekinumab at weeks 0, 4 and 16. Clinical response was evaluated monthly during treatment up to a 15-month follow-up period. All patients promptly showed a decrease in erythema, follicular hyperkeratosis and scaling. After three injections, complete remission of skin lesions was achieved in four out of five cases and a significant clinical improvement was shown in one case. To the best of our knowledge, this is the largest case series reported on ustekinumab treatment in PRP. Our results, in addition to previous studies from other groups, suggest that ustekinumab may be a possible first-line treatment for PRP patients refractory to conventional therapies.

http://ift.tt/2gJ9cHQ

Unilateral rhinorrhoea: An atypical aetiology

Publication date: Available online 27 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Aussedat, C. Dorbeau, D. Bakhos




http://ift.tt/2ya29mO

Virtual Presurgical Planning Optimizes the Outcome for a Patient with Ameloblastoma

By the time 31-year-old Marcus King saw Ron Karni, MD, and Kunal Jain, MD, the ameloblastoma encompassed the majority of... Read the full article...

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Dr. Amber Luong Recognized for Clinical Excellence by UTHealth’s Women Faculty Forum

Amber Luong, MD, PhD, associate professor of otorhinolaryngology and research director for the department, has been recognized with the 2017... Read the full article...

http://ift.tt/2yatchR

Dr. William Yao Selected Faculty Member of the Year by ORL Residents

Each year, the faculty of the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School at UTHealth recognizes an... Read the full article...

http://ift.tt/2yb2XYp

Dr. Soham Roy, Dr. William Yao and Dr. Ibrahim Alava Receive Dean’s Teaching Excellence Awards

Soham Roy, MD, FACS, FAAP, Ibrahim "Trey" Alava, MD, and William Yao, MD, have been recognized with McGovern Medical School... Read the full article...

http://ift.tt/2yat3uP

P336 A 20-month-old male with anemia and pneumonia

A 20-mo-o male with 2-day history of fever and cough. He was pale on exam with Hgb 3 mg/dL, RBC 3.12 X106/μL, MCV <50 fL/RBC. Fecal occult blood was positive. CXR showed RML infiltrate. He was hospitalized and given blood, antibiotics started. Stool microscopy showed charcot-leyden crystals. H. pylori stool antigen was positive, fecal calprotectin was borderline (95 μg/g), and stool alpha-1-antitrypsin was elevated (330 mg/dL), but negative for parasites, bacteria and viruses. Hemosiderin-laden alveolar macrophages were demonstrated in gastric aspirate.

http://ift.tt/2zdwsco

P279 Post-authorization safety study of hyaluronidase-facilitated subcutaneous immunoglobulin 10% treatment in patients with primary immunodeficiency diseases

HyQvia (IGHy) is a recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous immunoglobulin (SCIG) 10% replacement therapy for adults with primary immunodeficiency diseases (PIDD). To acquire long-term safety data on IGHy, and assess prescribed treatment regimens and administration in routine clinical practice, a global post-authorization safety study was initiated in the United States in November 2015.

http://ift.tt/2iFPZLe

P205 Experience with a simplified eucapnic voluntary hyperventilation (evh) device for diagnosis of exercise-induced bronchospasm

Exercise-induced bronchospasm (EIB) is defined as a transient narrowing of the airway after exercise with decline in FEV1 by at least 10%.The diagnosis of EIB is charactertistically determined by spirometry conducted after exercise or a surrogate challenge such as EVH.We review our experience in a private practice in allergy /immunology with simplified EVH.

http://ift.tt/2zdwq4g

P295 Good syndrome: importance of early diagnosis

A 63 HIV-negative man with benign spindle-cell thymoma (diagnosed 2011) presented with acute hypoxic respiratory failure. Over two months, he was hospitalized twice for recurrent pneumonia secondary to Bordetella Bronchisepticapneumonia and treated with two courses of IV antibiotics. He presented to us with respiratory failure requiring endotracheal intubation two days after his last hospitalization. CT demonstrated thymoma, cavitary lesions, ground glass opacity, and bronchiectasis. Cultures revealed Bordetella Bronchisepticaand Pneumocystis Jirovecii.

http://ift.tt/2iFPYHa

P213 Efficacy of inhaled tiotropium for asthmatics uncontrolled using inhaled corticosteroid plus a long-acting beta2-agonist

For moderate persistent asthmatics that remain symptomatic on long-term anti-inflammatory inhaled corticosteroid (ICS) plus a long-acting beta2-agonist bronchodilator (LABA), the addition of inhaled tiotropium a long-acting anticholinergic agent, may provide additional efficacy in sub optimally controlled moderate persistent asthmatics.

http://ift.tt/2zdWVGD

P344 Urticaria associated with alcoholic beverage ingestion and subsequent desensitization

Adverse reactions to alcohol and alcoholic beverages are not uncommon. Both immunologic and nonimmunologic mechanisms have been proposed. We describe a case of an urticarial reaction to alcoholic beverages.

http://ift.tt/2iFG3la

P328 History of milk or soy protein intolerance in infancy in patients with eosinophilic esophagitis

Adverse reactions to milk and soy are common in infancy. The incidence of eosinophilic esophagitis (EoE) appears to be increasing, and dietary therapy has become a first-line treatment.

http://ift.tt/2zeOpax

P287 The big masquerade: atopy as the presenting symptom of DOCK8 deficiency

Delay in diagnosis of primary immunodeficiency diseases (PIDs) could be attributed to lack of medical awareness of masquerading symptoms concerning for PIDs. Clinical manifestations prompting evaluation for PIDs include recurrent infections; some PIDs present with mild infections in the context of common diseases. DOCK8 deficiency could present with predominant atopic symptoms.

http://ift.tt/2iGvzC2

P217 Salford lung study chronic obstructive pulmonary disease follow-up interviews: analyses by treatment comparisons and exacerbations

The Salford Lung Study in Chronic Obstructive Pulmonary Disease (SLS COPD) compared the initiation of once-daily fluticasone furoate/vilanterol 100/25μg (FF/VI) treatment versus continuation of usual care (UC). The annual rate of moderate or severe exacerbations was significantly lower for patients initiated on FF/VI compared with UC (Vestbo, NEJM 2016). We conducted a follow-up study to compare the experiences of patients completing SLS COPD, by exacerbation rate and randomized treatment.

http://ift.tt/2zd0Gw1

P209 Fluticasone propionate and fluticasone/salmeterol multidose dry powder inhalers in patients previously treated through alternative devices

A novel, multidose dry powder inhaler (MDPI) has been developed allowing for lower doses of fluticasone propionate (Fp) and Fp/Salmeterol (FS) compared to previously established metered dose and dry powder inhalers (MDI; DPI). Given the dosing differences, this post-hoc analysis was conducted to evaluate efficacy of Fp and FS MDPI in patients previously treated with Fp and FS MDI/DPI.

http://ift.tt/2iFioBq

P201 Comorbidity burden of children with asthma in the U.S.

Certain comorbid conditions can make asthma more severe and harder to control for school-aged children (SAC).

http://ift.tt/2zbM6EY

P340 Practice considerations in offering peanut oral immunotherapy (OIT) in the U.S.

Peanut allergy is a major health burden in the U.S. While POIT is not currently recommended in major guidelines nor is there an FDA-approved product, numerous practices offer it. This study was conducted to examine practice considerations for POIT.

http://ift.tt/2iHS1KR

P332 Role of toll-like receptor signaling in epithelial barrier dysfunction in eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a multifactorial, chronic, food-driven allergic disease characterized by epithelial barrier dysfunction and eosinophil-predominant allergic inflammation. Esophageal epithelial keratinocytes express functional Toll-like Receptors (TLR), but their role in disease pathogenesis is unclear. Recently, TLR2 and TLR3 have been identified as highly expressed on esophageal epithelium, and we have identified that TLR7 is differentially regulated by steroid and diet therapy for EoE.

http://ift.tt/2zdkpM8

P299 Plasma cell dyscrasia in primary selective IgM deficiency

There is an increased prevalence of autoimmunity and malignancies; however, no cases of plasma cell dycrasia have been described in selective IgM deficiency (SIGMD). We present two cases of SIGMD, one with multiple myeloma and secondary amyloidosis of the GI tract; and the second with IgAλ monoclonal gammopathy of undetermined significance (MGUS).

http://ift.tt/2iIWLQM

P291 Heterozygous TACI mutation in patient with recurrent macrophage activation syndrome and systemic JIA

Transmembrane activator and calcium-modulating cyclophilin ligand interactor (TACI) is a TNF receptor involved in B cell homeostasis, isotype switching, and innate immunity. PLCG2 encodes phospholipase CY2 (PLCY2), which catalyzes formation of secondary messengers for immune cell signaling.

http://ift.tt/2zbM6os

OR031 Preventive effect of subcutaneous C1 inhibitor in patients with very frequent attacks of hereditary angioedema

Prophylaxis with subcutaneous C1 inhibitor (C1-INH [SC]) provided excellent preventive effect against hereditary angioedema (HAE) attacks in the COMPACT study (NEJM 2017;376:1131-40) in type I/II HAE patients with attack frequency of ≥4 attacks/2 consecutive months. The prophylactic effect of C1-INH (SC) in severely affected patients (≥4 attacks/month) is not known, hence it was of interest to analyze this subgroup.

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P219 Isoflurane therapy for severe refractory status asthmaticus in children

Life threatening asthma is characterized by progressive respiratory failure, though early treatment can prevent airway damage. Some patients with status asthmaticus do not respond to more common medications (b2 agonist, magnesium, anticholinergics). Isoflurane, an inhalational anesthetic agent with bronchodilation properties is a possible alternative treatment.

http://ift.tt/2zdXDUb

P215 Description of baseline characteristics of pediatric allergic asthma patients including those initiated on omalizumab

In light of recent omalizumab approval for uncontrolled moderate-to-severe allergic asthma (AA) patients aged 6-11 years, baseline characteristics of this population were described from a real-world dataset.

http://ift.tt/2iFigBW

P211 A real-world assessment of asthma exacerbations in asthma patients newly treated with omalizumab

The study aimed to assess asthma exacerbations pre- and post-omalizumab initiation in a real-world environment.

http://ift.tt/2zcUd47

P207 Symptoms, asthma control, lung function, and corticosteroid sparing following omalizumab initiation in allergic asthma patients

Electronic medical records (EMR) containing clinical data were used to deepen knowledge of omalizumab effectiveness in a real-world setting.

http://ift.tt/2iFPPn6

Barosinusitis: Comprehensive review and proposed new classification system

http://ift.tt/2y9qY2l

Evaluation of a new and simple classification for endoscopic sinus surgery

http://ift.tt/2lklRpG

The study of a possible correlation between serum levels of interleukin 17 and clinical severity in patients with allergic rhinitis

http://ift.tt/2y9oMHV

Prenatal maternal depression related to allergic rhinoconjunctivitis in the first 5 years of life in children of the EDEN mother-child cohort study

http://ift.tt/2lnbS34

Characterization of T-cell subpopulations in patients with chronic rhinosinusitis with nasal polyposis

http://ift.tt/2yak10M

A multicenter, prospective, noninterventional study in a Norwegian cohort of patients with moderate-to-severe allergic rhinitis treated with MP-AzeFlu

http://ift.tt/2lojy56

Oral immunotherapy in children with IgE-mediated hen's egg allergy: Follow-ups at 2.5 and 7 years

http://ift.tt/2yaFlTM

Long-term omalizumab use in the treatment of exercise-induced anaphylaxis

http://ift.tt/2lkurF0

Long-term follow-up of a patient with malignant transformation of inverted papilloma into sinonasal undifferentiated carcinoma

http://ift.tt/2yaFkPI

Multiple doses of icatibant used during pregnancy

http://ift.tt/2lnelL1

An ergonomic assessment of operating table and surgical stool heights for seated otolaryngology procedures

http://ift.tt/2yaFjeC

Acquired Vascular Tumors of the Head and Neck

Vascular neoplasms of the head and neck present with a wide spectrum of signs and symptoms. Diagnosis requires a high index of suspicion and is usually made after tumors are large enough to be visually apparent or cause symptoms. This article discusses the most common acquired benign and malignant vascular tumors, with an emphasis on their evaluation and treatment.

http://ift.tt/2gR8Enb

A risk adjustment approach to estimating the burden of skin disease in the United States

Direct insurance claims tabulation and risk adjustment statistical methods can be used to estimate health care costs associated with various diseases. In this third manuscript derived from the new national Burden of Skin Disease Report from the American Academy of Dermatology, a risk adjustment method that was based on modeling the average annual costs of individuals with or without specific diseases, and specifically tailored for 24 skin disease categories, was used to estimate the economic burden of skin disease.

http://ift.tt/2hgZ89E

Stress and Skin Disease Quality of Life: The Moderating Role of Anxiety Sensitivity Social Concerns

Summary

Background

Stress is an important factor in the onset, exacerbation, and reoccurrence of many skin diseases. Little is known about psychological risk factors that impact the association between stress and dermatologic conditions. One relevant factor that may modulate this link is anxiety sensitivity (AS) social concerns – the propensity to respond fearfully to anxiety-related sensations (e.g., sweating, flushing) due to perceived social consequences (e.g., rejection or humiliation).

Objective

To gain insight into psychological factors affecting skin disease, we examined the moderating role of AS social concerns in the relation between stress and skin disease quality of life (QOL).

Methods

Participants (N = 237; 161 female; M_age= 34.18, SD_age = 9.57) with active skin disease symptoms were recruited online and completed questionnaires assessing stress, AS social concerns, skin disease QOL, and global skin disease symptom severity.

Results

AS social concerns moderated the association between stress and skin-related emotional and social functioning in adults with skin disease. Stress was a significant predictor of the impairment associated with skin disease.

Conclusions

Stress was linked to skin disease-related emotional and functional impairment associated with skin disease among individuals with high AS social concerns. These results highlight the potential for AS reduction interventions to break the vicious cycle of stress and skin disease symptoms and to improve psychosocial well-being in dermatology patients.

This article is protected by copyright. All rights reserved.

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Insufficient generation of Th17 cells in IL-23p19-deficient BALB/c mice protects against progressive cutaneous leishmaniasis

http://ift.tt/2gISVmi

The JAK2/STAT3 pathway is involved in the anti-melanoma effects of atractylenolide I

http://ift.tt/2yYG5KP

A systematic review and meta-analysis of utility estimates in melanoma

Summary

We sought to determine pooled estimates of utility-based health-related quality-of-life (HRQOL) (utilities) for people with American Joint Cancer Committee stage I/II, III, IV melanoma for use in economic evaluations.

We performed a systematic review, meta-analysis, and meta-regression of utilities for melanoma patients. HRQOL scores reported with QLQ-C30, SF-36, SF-12, FACT-G, and FACT-M instruments were converted to utilities using published mapping algorithms. Meta-analysis was used to calculate mean utilities. Meta-regression examined the effects of baseline patient and study characteristics.

We identified 33 studies reporting 213 utilities. From meta-analyses, the mean utility for stage I/II melanoma was 0.970 (95%CI: 0.895-0.979); for stage III melanoma was 0.766 (95%CI: 0.699-0.833); for stage III/IV was 0.763 (95%CI: 0.755-0.771) and for stage IV melanoma was 0.764 (95%CI: 0.714-0.813). The difference in utility between stage III and stage IV was not statistically significant (p=0.521). For patients with stage I/II, the utility estimate at time of surgery was 0.772 (95%CI: 0.753-0.790), and from 3-12 months post-surgery, the utility estimate was 0.852 (95%CI: 0.844-0.860). Utility estimates for patients with stage IV melanoma were 0.653 (95%CI: 0.621-0.685) during the first 3 months of treatment and 0.831 (95%CI: 0.808-0.855) from 4-12 months on treatment. For patients with stage IV melanoma treated with chemotherapy, the utility estimate was 0.518 (95%CI: 0.513-0.523), while for those treated with targeted therapy, the utility estimate was 0.834 (95%CI: 0.822-0.846).

These robust, evidence-based estimates of health state utility can be used in economic evaluations of new treatments for patients with early stage or advanced stage melanoma.

This article is protected by copyright. All rights reserved.

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Epidemiology of Staphylococcal Scalded Skin Syndrome in United States Children

Abstract

Background

Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. We sought to describe the incidence, costs, length of stay (LOS), comorbidities, and mortality of SSSS in US children.

Methods

The Nationwide Inpatient Sample 2008-2012 was analyzed, including a 20% sample of US hospitalizations and 589 cases of SSSS.

Results

The annual incidence of SSSS was 7.67 (range: 1.83–11.88) per-million US children, with 45.1 cases per-million US infants age <2 years. In multivariate logistic regression models, SSSS was significantly associated with female sex (adjusted odds ratio [95% confidence interval]:1.12 [1.00–1.25]), age (2-5yr:13.31 [11.82-14.99], 6-10yr:2.93 [2.35–3.66], 11-17yr:0.44 [0.31–0.63]), race/ethnicity (blacks:0.69 [0.58–0.84]), season (winter:2.04 [1.66–2.50], summer:3.47 [2.86–4.22], fall:3.04 [2.49–3.70]), with increasing odds over time (2010-2011:2.28 [2.07–2.51], 2012:2.98 [2.69–3.30]). The geometric mean (95% CI) LOS and cost of hospitalization for patients with vs. without SSSS was 3.2 (3.0-3.4) vs. 2.4 (2.4-2.5) days and $4,624.0 [$4,250.8-$5,030.1] vs. $1,871.7 [$1,782.7-$1,965.1]. Crude inpatient mortality rates were similar for children with vs. without SSSS (0.33% [0.00–0.79%] vs. 0.36% [0.34-0.39%]). SSSS was associated with other infections, including in upper respiratory tract and skin.

Conclusions

SSSS prevalence appears to be increasing over time, and was associated with a number of socio-demographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.

This article is protected by copyright. All rights reserved.

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Job change facilitates healing in a cohort of patients with occupational hand eczema

Abstract

Background

Occupational hand eczema is a frequent and often chronic disease and knowledge of the consequences of change of profession is sparse.

Objectives

To compare severity of hand eczema and health related QoL HR-QoL in patients who after 5 years were still in the same profession and those who were not.

Methods

The study is a register-based cohort study including patients with recognised occupational hand eczema in Denmark in 2010 and 2011. Outcomes were eczema related parameters and Dermatology Life Quality Index (DLQI) obtained from a follow-up questionnaire after 5 years.

Results

A total of 1496 participants were included in the study. More participants who changed or ended profession reported complete healing of hand eczema at follow up, compared to participants still in the same profession (OR=1.62 (1.06-2.47) and OR=2.85 (1.83-4.42), respectively), as well as increased improvement at follow-up (OR=1.91(1.44-2.54) and OR=1.51(1.09-2.10), respectively), while DLQI for participants who changed or ended profession was increased at follow up, (Incidence Rate Ratio (IRR)= 1.12 (0.98-1.28) and IRR= 1.29 (1.11-1.51), respectively). Subgroup analyses of patients with irritant or allergic occupational hand eczema did not differ markedly from this result. Change of work procedures was positively associated with improvement (OR=2.31(1.51-3.54)), and did not markedly influence DLQI.

Conclusion

Change of profession has a beneficial effect on eczema parameters, but a negative effect on HR-QoL, indicated by increased DLQI. Change of work procedures while staying in the same profession positively influenced improvement, with no marked influence on HR-QoL, and should be considered as an alternative to job change.

This article is protected by copyright. All rights reserved.

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In vivo Zika virus detection in human skin

Abstract

Zika virus (ZIKAV) a Flavivirus mainly transmitted by Aedes aegypti and Aedes albopictus mosquitoes has been responsible for an extensive epidemic affecting people in more than 56 countries since its emergence in Brazil in 2015 (1). Evidence of the neuroinvasiveness and the tropism of ZIKAV for placenta trophoblasts has turned an infection, originally known for its mildness, into a major world public health concern due to the severity and dissemination of associated disorders (i.e.: congenital Zika syndrome and Guillain Barré syndrome) (2). Despite a commonly short viremia of low intensity the spread of ZIKAV infection is primarily due to vectorial transmission rather than to vertical or sexual transmission which have recently been evidenced (3-5).

This article is protected by copyright. All rights reserved.

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Laser treatment of congenital melanocytic nevi: a systematic review

Summary

Recent studies on congenital melanocytic nevi (CMN) indicate a lower risk for melanoma than assumed for many years. As a result, the treatment paradigm in CMN shifted from complete removal to cosmetically acceptable, less invasive treatment options such as laser treatment. Our objective was to systematically review the efficacy and safety of laser therapy for CMN. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. We rated the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-four eligible studies with 434 patients were included, three non-randomised controlled studies and 21 case series (majority of poor quality). Twenty different laser modalities or combinations were evaluated. Overall, the Q-switched laser was used most frequently, although large or giant CMN were generally treated with an ablative laser. Due to heterogeneity between studies, comparison between laser modalities was hampered and statistical analysis was precluded. Lasers in CMN showed rather good results for clearing of hyperpigmentation on the short term, albeit very low quality evidence. Outcome measures varied widely, patient satisfaction was hardly measured and high incidences of scarring, repigmentation and complications were reported. No malignant change was seen. While most studies report short-term improvement of CMN after laser therapy, there is no high quality evidence for the efficacy and safety of laser modalities in CMN on the long term. Future research should focus on well-conducted, and well-reported prospective studies on different laser modalities for CMN, with use of recognised and validated outcome measures.

This article is protected by copyright. All rights reserved.

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Postzygotic mosaïcism and incontinentia pigmenti in male patients:molecular diagnosis yield

Abstract

Incontinentia pigmenti (IP, MIM 308300) is an X-linked dominant genodermatosis caused by the more frequently occurring (80% of cases) deletion mutation Δ 4-10 on IKBKG gene, located on chromosome Xq28. Incontinentia Pigmenti is generally lethal in male fetuses, while heterozygous females survive owing to functional mosaicism.¹ Two potential mechanisms have been proposed to explain the survival of male patients with IP carrying IKBKG mutation: (1) abnormal karyotype, i.e. 47, XXY Klinefelter syndrome; (2) more frequently postzygotic mosaicism for IKBKG mutation.² Detection of postzygotic mosaicism is dependant of tissue sampling localization and percentage of mutated cells in the sample.

This article is protected by copyright. All rights reserved.

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Natural history and clinical outcome of junctional epidermolysis bullosa generalized intermediate due to a LAMA3 mutation

Abstract

Junctional epidermolysis bullosa (JEB) comprises rare autosomal recessive disorders with a broad spectrum of clinical features and severity. The genetic basis involves mutations in genes encoding proteins of the dermal-epidermal junction, primarily laminin 332. This heterotrimeric glycoprotein consists of laminin α3, β3 and γ2 chains, and the majority of mutations in the respective genes (LAMA3, LAMB3, and LAMC2) lead to premature termination codons resulting in severe generalized JEB (previously Herlitz)¹.

This article is protected by copyright. All rights reserved.

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Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomised controlled feasibility trial

Abstract

Background

Almost 70% of all leg ulcers have a venous component. Venous leg ulcers (VLU's) are typically painful and heal slowly, resulting in an impaired quality of life (QoL), social isolation and reduced work productivity. Compression therapy offers high healing rates, however, improvements aren't usually sustained. Exercise is a low-cost, low-risk, and effective strategy for improving physical and mental health. However, little is currently known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy in this patient group.

Objectives

To assess the feasibility of a 12-week supervised exercise programme combining aerobic, resistance and flexibility exercises as an adjunct therapy to compression in patients with VLU's.

Methods

This was a two-centre, two-arm, parallel-group, randomised feasibility trial. Thirty-nine patients with venous ulcers were recruited and randomised 1:1 either to exercise (3 sessions per week) and compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow-up and patients' preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year following baseline, with healing rate and time, ulcer recurrence and infection incidents also being documented. Intervention and healthcare utilisation costs were calculated. Qualitative data was collected to assess participants' experiences.

Results

Overall, 72% of the exercise group participants attended all scheduled exercise sessions. No serious adverse events, and only two exercise-related adverse events (e.g., increased ulcer discharge) were reported. Loss to follow-up was 5%. At 12-months median ulcer healing time was lower in the exercise group (13 vs 34.7 weeks). Total NHS costs were calculated as £813.27 for the exercise and £2,298.57 for the control group.

Conclusions

Our findings support the feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures. The next step will be the design and implementation of an appropriately-powered, multi-centre trial.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xtQF9k

Correction: Radioembolisation mit Yttrium-90-Mikrosphären

Zusammenfassung

Hintergrund

Die selektive interne Radiotherapie ist eine innovative endovaskuläre minimalinvasive Therapie zur Behandlung von primären Leberneoplasien und Lebermetastasen.

Ziel

Es erfolgt eine Beschreibung der Technik und Anwendungsgebiete.

Ergebnisse

Die selektive interne Radiotherapie (SIRT) stellt inzwischen eine wichtige Säule in der Erst- und Zweitlinientherapie beim Cholangio- und hepatozellulären Karzinom dar. Bei Lebermetastasen kommt die Radioembolisation (⁹⁰Y-RE) meist zum Einsatz, wenn die Metastasierung unter Chemotherapie progredient ist und sich auf die Leber beschränkt („liver only") oder dominant („liver dominant") ist. Diese Therapieindikation wird vereinzelt auch als Salvage-Situation oder chemorefraktäre Situation bezeichnet.

Schlussfolgerung

Die Evidenzlage für die SIRT wird durch neuere Studien deutlich verbessert. Inzwischen findet die SIRT als alternatives Therapiekonzept für die Behandlung von Leberneoplasien Einzug in die onkologischen Leitlinien.

http://ift.tt/2zW4zTg

Fehlerhafte Primärdiagnostik beim Mammakarzinom

http://ift.tt/2xu0GDa

Re: “Dynamic Risk Stratification for Predicting Recurrence in Patients With Differentiated Thyroid Cancer Treated Without Radioactive Iodine Remnant Ablation Therapy” by Park et al.

Thyroid , Vol. 0, No. 0.


http://ift.tt/2xukoix

What are the clinically important outcome measures in the surgical management of nasal obstruction?

Abstract

Objectives

to assess the correlation between the Nasal Obstruction Symptom Evaluation (NOSE) scale and peak nasal inspiratory flow (PNIF) measurement, and to determine which outcome variable correlates with patient satisfaction and thereby, successful surgical outcome.

Design

Prospective case series.

Setting

Rhinology practice in a tertiary referral centre (Liverpool, U.K).

Participants

Patients having surgery (septoplasty, turbinoplasty) for nasal obstruction.

Main outcome measures

NOSE, PNIF, 5-point Likert scale (weighted from "very satisfied" to "not at all satisfied") and a 10 cm visual analogue scale (0 = not at all satisfied, 10 = very satisfied).

Results

Forty-five (15 female) had complete datasets available for analysis. The mean pre-operative NOSE score was 78.4 (standard deviation, SD 14.8) and improved significantly to 23.0 (SD 19.1) post-operatively. A similar trend was observed where the mean pre-operative PNIF improved significantly by 40% from 91.8L/min (SD 28.2) to 139.9 (SD 27.9) following surgery. The mean improvement in NOSE score of the overall study cohort was 55.4 (SD 22.3) while the mean improvement in PNIF was 48.0 (SD 31.1). Although no correlation was observed between pre- and post-operative NOSE and PNIF, a significant (p = 0.01) but weak positive correlation (r = 0.39) was observed between the magnitude of change in NOSE and PNIF. The mean change in NOSE score of patients who were "very satisfied" with their nasal operation was 64.0 (SD 18.5), significantly higher compared to 39.2 (SD 17.9) in patients who were "satisfied".

Conclusions

Patients who rate being either "satisfied" or "very satisfied" demonstrated significant improvement in NOSE and PNIF following their nasal surgery; the magnitude being twice the calculated minimal clinically important difference.

This article is protected by copyright. All rights reserved.

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Propranolol in the preoperative treatment of Kasabach–Merritt syndrome: a case report

Kasabach–Merritt syndrome represents the association of hemangioma with thrombocytopenia and consumptive coagulopathy. We present a case of Kasabach–Merritt syndrome treatment with orally administered proprano...

http://ift.tt/2yPY2f8

Tumoral calcinosis in the cervical spine: a case report and review of the literature

Tumoral calcinosis is rarely located in spine. A 55-year-old Japanese woman with cervical tumoral calcinosis is presented, along with a review of the literature relating to tumoral calcinosis in the spine. We ...

http://ift.tt/2gP3cAX

Merkel Cell Carcinoma: Not Just Another Skin Cancer

Merkel cell expert Paul Nghiem, MD, PhD, explains how this rare but deadly condition differs from other forms of skin cancer.
Medscape Dermatology

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Effects of intratympanic dexamethasone on noise-induced hearing loss: An experimental study

Publication date: Available online 27 October 2017
Source:American Journal of Otolaryngology
Author(s): Sait Serdar Gumrukcu, İlhan Topaloglu, Ziya Salturk, Belgin Tutar, Yavuz Atar, Güler Berkiten, Ayşe Enise Göker
AimAim of the study was to evaluate the effect of intratympanic steroid treatment on hearing based on oto-acoustic emission.MethodsA total of 16 healthy female Wistar albino rats weighing were used in this study. They were divided in to 2 groups and each group was exposed to noise at 110dB for 25min to induce acoustic trauma. Intratympanic dexamethasone was administered to the middle ears of animals in the experimental group on the same day as exposure to noise. The control group was given 0.09% saline solution. Distortion product otoacoustic emission measurements were performed on days 7 and 10.ResultsThere were no differences between the emission results of two groups before treatment at 4004, 4761, 5652, 6726, and 7996Hz. There were significant group differences on measurement days 7 and 10 at all frequencies.ConclusionOur study revealed a significant difference in DPOAE measurements on days 7 and 10 between the experimental and control groups. We detected a positive effect of dexamethasone on noise-induced hearing loss.



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Interferon response to RSV by bronchial epithelium from children with asthma is inversely correlated with pulmonary function

Publication date: Available online 26 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): M.C. Altman, S.R. Reeves, A.R. Parker, E. Whalen, K.M.S. Misura, K.A. Barrow, R.G. James, T.S. Hallstrand, S.F. Ziegler, J.S. Debley
BackgroundRespiratory viral infection in early childhood, including that from respiratory syncytial virus (RSV), has been previously associated with the development of asthma.ObjectiveWe aimed to determine whether ex vivo RSV infection of bronchial epithelial cells (BECs) from children with asthma would induce specific gene expression patterns, and whether such patterns associate with lung function among BEC donors.MethodsPrimary BECs from carefully characterized children with asthma (n=18) and matched healthy children without asthma (n=8) were differentiated at an air-liquid interface (ALI) for 21 days. ALI cultures were infected with RSV for 96 hours and RNA was subsequently isolated from BECs. In each case, we analyzed gene expression using RNA sequencing and assessed differences between conditions by linear modeling of the data. BEC donors completed spirometry to measure lung function.ResultsRSV infection of BECs from subjects with asthma led to a significant increase in expression of 6927 genes compared to uninfected BECs. There was a significantly increased expression of 195 genes in BECs from children with asthma and airway obstruction (FEV1/FVC<0.85 and FEV1<100% predicted) compared to children with asthma without obstruction, as well as compared to healthy children. These specific genes were found to be highly enriched for viral response genes induced in parallel with type I and III IFNs.ConclusionBECs from children with asthma and with obstructive physiology exhibit greater expression of type I and type III IFN and IFN-stimulated genes than cells from children with normal lung function, and expression of IFN-associated genes correlates with the degree of airway obstruction. These findings suggest that an exaggerated IFN response to viral infection by airway epithelial cells may be a mechanism leading to lung function decline in a subset of children with asthma.

Teaser

RSV-infected bronchial epithelial cells from children with asthma and obstructive physiology demonstrate greater expression of type I and III IFN-associated genes than cells from children without airway obstruction. Furthermore expression of IFN-associated genes inversely correlate with lung function.


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Anti-apoptotic Serine Protease Inhibitors contribute towards the survival of allergenic Th2 cells

Publication date: Available online 26 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Mohamed H. Shamji, Jeff N. Temblay, Wei Cheng, Susan M. Byrne, Ellen Macfarlane, Amy R. Switzer, Natalia D.C. Francisco, Fedina Olexandra, Fabian Jacubczik, Stephen R. Durham, Philip G. Ashton-Rickardt
BackgroundThe mechanisms regulating the maintenance of persistent Th2 cells that potentiate allergic inflammation are not well understood.ObjectiveThe function of Serine Protease Inhibitor 2A (Spi2A) was studied in mouse Th2 cells and Serine Protease Inhibitor (SERPIN) B3 and B4 genes were studied in Th2 cells from grass pollen allergic individuals.MethodsSpi2A deficient Th2 cells were studied in vitro culture or in vivo after challenge of Spi2A Knock-Out (KO) mice with ovalbumin in alum. The expression of SERPIN B3 and B4 mRNA was measured in vitro cultured Th2 cell and in ex vivo CD27^-CD4⁺ and ICL2 cells from grass pollen allergic individuals using quantitative PCR. SERPIN B3 and B4 mRNA levels were knocked down in cultured CD27^-CD4⁺ cells with shRNA.ResultsThere were lower levels of in vitro polarized Th2 cells from Spi2A KO mice (P<0.005) and in vivo after OVA challenge (P<0.05), higher levels of apoptosis (annexin V positivity P<0.005) and less lung allergic inflammation (number of lung eosinophils P<0.005). In vitro polarized Th2 cells from grass pollen allergic individuals expressed higher levels of both SERPIN B3 and B4 (both P<0.05) mRNA compared to un- polarized CD4 T cells. CD27^-CD4⁺ from grass pollen allergic individuals expressed higher levels of both SERPIN B3 and B4 (both P<0.0005) mRNA compared to CD27⁺CD4⁺ cells. ICL2 cells expressed higher levels of both SERPIN B3 and B4 (both P<0.0005) mRNA compared to ICL1 cells. Knock-down of either SERPIN B3 or B4 (both P <0.005) mRNA levels resulted in decreased viability of CD27^-CD4⁺ compared to control transduced cells.ConclusionThe serpins Spi2A in mice and Serpin B3 and B4 in allergic individuals, control viability of Th2 cells. This provides proof-of-principle for a therapeutic approach for allergic disease through the ablation of allergic memory Th2 cells through mRNA SERPIN B3 and B4 down-regulation.



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Chronic Rhinosinusitis: Endotypes, Biomarkers and Treatment Response

Publication date: Available online 26 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jose Gurrola, Larry Borish
It is increasingly recognized that chronic rhinosinusitis (CRS) comprises a spectrum of different diseases with distinct clinical presentations and pathogenic mechanisms. Defining the distinct phenotypes and endotypes of CRS impacts prognosis and most importantly is necessary as the basis for making therapeutic decisions. The need for individualized defining of pathogenic mechanisms prior to initiating therapy extends to virtually all therapeutic considerations. This is clearly crucial with antibiotics where, barring an influence from their off-target anti-inflammatory pharmacological effects, an understanding of the role of individual biome predicts likelihood of therapeutic benefit. But this need for identifying individual phenotypes and endotypes also extends to the agent that is currently considered the mainstay of treatment of CRS, specifically glucocorticoids (GCS). As with asthma, it is recognized that a large minority of CRS patients have a steroid-resistant phenotype, identification of which will preclude use of these agents with their potential side effects. Identification of endotypes is also becoming increasingly imperative as targeted biotherapeutic agents, such as anti-IgE and anti-cytokine antibodies are becoming available. These agents are likely to benefit patients in whom the targeted mediator is not only expressed but demonstrably driving a central mechanism in that individual. In summary, the treatment of CRS is at an exciting crossroad. On the positive side, numerous therapeutics are in development that seem likely to positively impact our patients who suffer from this condition. The challenge is that these therapies will require targeted individualized treatments based upon identifying subjects with the relevant endotype.



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Violence at Verteba Cave, Ukraine: New Insights into the Late Neolithic Intergroup Conflict.

Abstract

Many researchers have pointed to the huge "megasites" and construction of fortifications as evidence of intergroup hostilities among the Late Neolithic Tripolye archaeological culture. However, to date, very few skeletal remains have been analyzed for the types of traumatic injury that serve as direct evidence for violent conflict. In this study, we examine trauma on human remains from the Tripolye site of Verteba Cave in western Ukraine. The remains of 36 individuals, including 25 crania, were buried in the gypsum cave as secondary interments. The frequency of cranial trauma is 30-44% among the 25 crania, six males, four females and one adult of indeterminate sex displayed cranial trauma. Of the 18 total fractures, 10 were significantly large and penetrating suggesting lethal force. Over half of the trauma is located on the posterior aspect of the crania, suggesting the victims were attacked from behind. Sixteen of the fractures observed were perimortem and two were antemortem. The distribution and characteristics of the fractures suggest that some of the Tripolye individuals buried at Verteba Cave were victims of a lethal surprise attack. Resources were limited due to population growth and migration, leading to conflict over resource access. It is hypothesized that during this time of change burial in this cave aided in development of identity and ownership of the local territory.

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Editorial board

Publication date: November 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 11





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Calendrier

Publication date: November 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 11





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Journées dermatologiques de Paris 2017

Publication date: Available online 26 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E. Delaporte




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Dermatose neutrophilique du dos des mains après une griffure de lapin

Publication date: Available online 16 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Cariou, L. Tisseau, L. Darrieux, G. Safa, N. Ropars




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Lipœdème du cuir chevelu

Publication date: Available online 16 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): L. Chaplain, P. Moguelet, A. Barbaud, P. Senet
IntroductionLe lipœdème du cuir chevelu, alopéciant ou non alopéciant, est une entité mal connue et rarement rapportée. Elle a été décrite pour la première fois en 1935 par Cornbleet. Il s'agit d'une augmentation de l'épaisseur du tissu sous-cutané du cuir chevelu, responsable d'un empâtement global de celui-ci, associée ou non à une alopécie, un prurit ou des sensations douloureuses. À l'heure actuelle, moins de 50 cas de lipœdème du cuir chevelu (alopéciant ou non) ont été rapportés dans la littérature.ObservationNous présentons ici le cas d'une femme de 36 ans, originaire de Côte d'Ivoire, qui a présenté des douleurs associées à une infiltration cliniquement palpable de l'ensemble du tissu sous-cutané du cuir chevelu. L'infiltration a été confirmée par l'imagerie en résonance magnétique (IRM). La biopsie n'était pas contributive.DiscussionNous avons diagnostiqué un nouveau cas de lipœdème du cuir chevelu non alopéciant chez une femme d'origine africaine. Aucune cause n'a été trouvée. L'abstention thérapeutique semblait l'attitude la mieux adaptée.BackgroundLipedematous scalp, with or without alopecia, is a poorly known and rarely reported entity. It was first described in 1935 by Cornbleet. It involves increased thickness of the subcutaneous tissue of the scalp, responsible for an overall thickening of the scalp, which may be associated with alopecia, pruritus or painful sensations. Currently, fewer than 50 cases of lipedematous scalp, both with and without alopecia, have been reported in the literature.Patients and methodsHerein we present the case of a 36-year-old woman from the Ivory Coast, who presented scalp pain associated with infiltration of the entire subcutaneous tissue of the scalp seen clinically and confirmed at MRI. Histology added nothing.DiscussionWe diagnosed a new case of lipedematous scalp in an African woman. No cause was found. Therapeutic abstention appears the best management strategy.



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Papulose lymphomatoïde

Publication date: Available online 14 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Andrea, M. Perier-Muzet, S. Dalle




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Tumeur fibroépithéliale de Pinkus : corrélation dermatopathologie-dermatoscopie

Publication date: Available online 14 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Huet, G. Barnéon, B. Cribier




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Eczéma photo-aggravé à la méthylisothiazolinone

Publication date: Available online 13 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




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Lésions cutanées secondaires à la médecine des ventouses (hijama)

Publication date: Available online 13 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger, J.-J. Fraslin




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Forthcoming Meetings

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Towards safer oral immunotherapy for food allergy and allergic asthma is still increasing in prevalence

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Cover Image

The cover image, by P. Brinkman et al., is based on the Original Article Exhaled breath profi les in the monitoring of loss of control and clinical recovery in asthma, DOI: 10.1111/cea.12962.

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Issue Information

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Mometasone vs Budesonide in CRS With Polyposis

Condition:   Chronic Rhinosinusitis (Diagnosis), Nasal Polyposis
Interventions:   Drug: Budesonide 0.5 MG/ML;   Drug: Mometasone nasal spray
Sponsor:   Université de Sherbrooke
Recruiting

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Phase II Trial Assessing the Efficacy of Immuno-Radiation Abscopal Effect in Patients With Metastatic Cancers

Conditions:   Metastatic Breast Cancer;   Metastatic Colorectal Cancer;   Metastatic Head and Neck Cancer
Interventions:   Radiation: Systemic treatment + Stereotactic Body Radio-Therapy (SBRT);   Other: Systemic treatment
Sponsors:   Institut de Cancérologie de la Loire;   Saint-Louis Hospital, Paris, France;   Gustave Roussy Institute
Not yet recruiting

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Two cases of occupationally acquired Mycobacterium marinum infection in Chinese restaurant workers in Melbourne, Australia

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Myocardial bridge: bridging the differential diagnosis

A 50-year-old man with a history of vasospastic angina diagnosed 3 months prior presented with recurrent episodes of substernal chest pain. His chest pain was characterised as 'squeezing', lasting 10 min and typically occurred on awakening. Medications included isosorbide, nitroglycerin and ranolazine; however, due to lack of insurance he was unable to obtain these medications. On admission, patient was given a full-dose aspirin and nitroglycerin, which acutely worsened his chest pain. ECG did not reveal ischaemic changes and initial troponin was negative. A left heart catheterisation was conducted, revealing a myocardial bridge of the mid-left anterior descending artery. Myocardial bridge, due to its rarity, is often overlooked as an aetiology for angina, myocardial ischaemia, acute coronary syndrome, syncope and cardiac death. This case highlights the importance of broadening the differential to include myocardial bridge in the work-up for chest pain, especially if nitrates worsen symptoms.

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Fast-tracked Rehabilitation and Return to Sport of an Elite Rugby Player with a Complicated Posterolateral Corner Injury and Associated Peroneal Paralysis

Acute posterolateral corner injuries of the knee with associated hamstring avulsions and peroneal paralysis are rare in rugby. Regain of motor function following a complete paralysis is documented to be 38%. To our knowledge, only one case describes return to preinjury level of competitive sport taking up to 27 months. A 24-year-old international level rugby player, a medical student, sustained an acute posterolateral knee injury with associated anterior cruciate ligament tear, bicep femoris and semimembranosus avulsions as well as a complete peroneal paralysis. The patient returned to full-time medical rotation work weeks at 5 months. At 10 months, the patient was considered to have returned to preinjury level of activity having managed a 5 km run, participated regularly in non-contact rugby and performed exercises at 140% of his preinjury maximum. This case report describes the successful outcome of a high-frequency high-intensity rehabilitation.

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Not all is lost: journey of a deep periorbital burn

Description

A 16-year-old male presented with deep dermal burns of upper and lower eyelids and decreased vision in left eye after falling on a hot silencer of a motorcycle 2 weeks before. His best-corrected visual acuity was 6/6 and light perception in right and left eye, respectively. Skin over the left side of the nose, root of the nose and right medial brow area was necrotic extending up to submusculoaponeurotic layer (figure 1A). There was localised corneal perforation inferiorly with iris prolapse and shallow anterior chamber in left eye. Urgent debridement was performed under general anaesthesia. Necrosis was involving tarsal plates in both the eyelids. Corneal perforation was sealed with cyanoacrylate glue along with permanent tarsorrhaphy to prevent exposure keratopathy. Three weeks later, eyelid was reconstructed with split thickness skin graft harvested from right anterolateral thigh along with paramedian forehead musculocutaneous flap (figure 1B). Corneal...

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Chronic hypertension, recreational cocaine use and a subsequent acute aortic dissection in a young adult

Cocaine is a widely used illicit substance and has previously been described as a risk factor for aortic dissection. We present a case of a young recreational cocaine user with uncontrolled hypertension who presented to hospital with acute chest pain and was diagnosed with an acute aortic dissection. The patient's last use of powdered cocaine was 3 days prior. A workup for secondary hypertension was negative and no other risk factors for aortic dissection were determined. In hospital, the patient was medically managed with multiple antihypertensive agents, was provided with education regarding the risk of ongoing stimulant use and resources to support his goal of abstinence. This case highlights the importance of considering a diagnosis of aortic dissection in a young patient presenting with acute chest pain, underscores the need for a thorough substance use history and provides a novel example of the potential danger of even recreational cocaine use.

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Splenic hematoma as a consequence of pneumoperitoneum

Abstract

Splenic injury is a rare but serious complication of bariatric surgical procedures. Given that the need for dissection of the gastrosplenic ligament during bariatric surgical procedures, splenic injury is not unfathomable. While most subcapsular splenic hematomas may be self-limiting, continued expansion may result in splenic rupture and should, therefore, be handled with great care. With the growing rate of bariatric surgical procedures worldwide, inadvertent intra-operative splenic injury may become a more prevalent surgical complication. We report that the first documented case of subcapsular hematoma and associated gas collection following laparoscopic sleeve gastrectomy, as well as, a proposed mechanism for the radiographic findings and potential complications.

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Suppurative appendicitis presenting acute scrotal pain: a rare condition may confuse surgeons

Abstract

Scrotal pain presentation has many differential diagnoses such as testicular torsion is surgical emergency. For this reason, it is necessary for surgeons to differentiate between diseases for choosing the best treatment approach. We have reported a rare condition of 19-year-old male case had an atypical scrotal pain presentation of appendicitis. He was admitted to emergency service with 4 days history of pain in abdomen and testis. In physical examination, there is tenderness in right lower quadrant, right inguinal region and scrotum. Testicular torsion and appendicitis were roll-out in sonography. Because of low sensitivity of sonography in diagnose of appendicitis and high suspicious of surgeons, the case was candidate for an open appendectomy surgery. Acute suppurative appendicitis that presenting testicular pain is rare for making the best diagnosis and prevents multiple surgeries in such cases, cooperation of urology, general surgery and radiology specialists with high index of suspicion is required

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Cardiac tamponade communicating with a posterior mediastinal chylocele after esophagectomy

Abstract

A 75-year-old male received neoadjuvant chemotherapy for locally advanced squamous cell carcinoma of the mid-thoracic esophagus, followed by right transthoracic esophagectomy with extended mediastinal lymphadenectomy. Cardiac tamponade developed on postoperative Days 1 and 13, for which emergency ultrasound-guided drainage was required. Pericardial drainage fluid became chylous after administration of polymeric formula. A computed tomography scan demonstrated the presence of a retrocardiac fluid collection, encompassed by the left pulmonary vein and left atrium, descending aorta and vertebral column. Based on these findings, the diagnosis of chylopericardial tamponade communicating with a posterior mediastinal chylocele was made. The ligation of the thoracic duct was successfully performed via the left-sided thoracoscopic approach on postoperative Day 20 and the clinical course after the second operation was uneventful. The possible mechanisms of this exceptionally rare complication after esophagectomy were discussed.

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A record-breaking lung metastasis from renal cell carcinoma 37 years after nephrectomy

Abstract

Development of distant metastases from renal cell carcinoma (RCC) is a frequent occurrence and, in nearly 95% of the cases, secondary lesions present within 5 years following nephrectomy. We performed a left pneumonectomy for a peri-hilar lung mass in an 81-year-old man with history of kidney cancer, resected 37 years earlier. Histopathological examination revealed a solitary lung metastasis from RCC, relapsed after an extraordinary 37-year time interval. To the best of our knowledge, this remarkable case represents the longest time interval between radical nephrectomy for RCC and the occurrence of a pulmonary metastasis. After an uneventful post-operative recovery, there are no signs of disease recurrence at a 3-year follow-up. The possibility of a lung metastasis should be taken into account in patients with history of RCC who present with pulmonary nodules, even decades after treatment of the primary neoplasm.

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Preoperative determination of nerve of origin in patients with vestibular schwannoma

Abstract

Background

Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin.

Methods

The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively.

Results

The novel scoring system was applied to five consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery.

Conclusion

The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.

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Developing a synchronous otolaryngology telemedicine Clinic: Prospective study to assess fidelity and diagnostic concordance

Objective

To evaluate diagnostic concordance of a synchronous telemedicine otolaryngology clinic with use of currently available technology.

Study Design

Prospective.

Methods

Patients in a rural otolaryngology clinic were enrolled in a pilot telemedicine clinic. To assess system fidelity, an on-site and remote (consulting) otolaryngologist conducted simultaneous patient evaluations using streaming telecommunication technology for all aspects of the clinical encounter, including high-definition examination and endoscopic images. Both physicians and patients were blinded and diagnoses recorded. Post-encounter physician surveys and an original patient-centered TeleENT Satisfaction Questionnaire (TESQ) were used to assess overall satisfaction.

Results

Twenty-one patients were enrolled consecutively. Visual technology was found acceptable in all cases, and audio technology was acceptable in 20 of 21 encounters. Patient satisfaction was 96%, and patients felt comfortable using a telemedicine system in the future. Encounters were not significantly longer than traditional encounters. Physician diagnostic agreement was found in 95% of cases, and the consulting physician indicated that all encounters provided sufficient history, examination, and high-quality images to generate an accurate diagnosis, order additional workup, and/or make an appropriate referral.

Conclusion

A synchronous otolaryngology telemedicine clinic is comparable to a standard clinic in terms of diagnostic concordance and patient satisfaction when using streaming technology and high-definition images. Using telemedical technology may be a viable way to increase otolaryngology access in remote or underserved areas. With system validity now established, future studies will assess the feasibility of using trained on-site physician extenders (nurse practitioners or physician assistants) to conduct in-person patient encounters with remote otolaryngologist support.

Level of Evidence

2c. Laryngoscope, 2017

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Topical protection of mice laryngeal mucosa using the natural product cashew gum

Objectives/Hypothesis

Evaluate the effect of in vitro exposure of mice laryngeal mucosa to solutions that simulated human gastric juice and to assess the topical protective effect of cashew gum on mice laryngeal mucosal integrity in vitro.

Study Design

Animal study.

Methods

Murine (Swiss) laryngeal samples were mounted in Ussing chambers. The luminal side of biopsies was exposed to solutions of different acidity with or without pepsin and/or taurodeoxycholic acid (TDC). Transepithelial electrical resistance (TER) was continuously recorded. The topical protective effect of cashew gum solution was evaluated by precoating the biopsies before the exposure with a solution at pH 5 containing 5 mM TDC. Changes in TER and mucosal permeability to fluorescein were measured.

Results

Exposure of laryngeal mucosa to acidic solutions containing pepsin and TDC provoked a pH-dependent drop in TER with the maximal effect at pH 1, but still present at pH 5 (weakly acidic). The exposure of the laryngeal mucosa to a solution of pH 5 with TDC, but not with pepsin, produced a dose-dependent decrease in TER. Precoating the mucosa with cashew gum prevented the reduction of TER and increased transepithelial permeability by exposure to a solution at pH5 containing TDC.

Conclusions

Weakly acidic solutions containing bile acids can produce impairment of laryngeal epithelial barrier, which may be protected by topical treatment with cashew gum.

Level of Evidence

NA Laryngoscope, 2017

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Assessment of laryngeal cancer in patients younger than 40 years

Objectives/Hypothesis

To assess the differences between patients with laryngeal squamous cell carcinoma under 40 years old and those 40 years old or older. A secondary objective was to compare survival outcome between these cohorts.

Study Design

Retrospective chart review.

Methods

We reviewed the medical charts of all patients treated in our tertiary referral center for laryngeal squamous cell carcinoma from 2005 to 2014. Patients aged < 40 years at diagnosis were compared to older patients.

Results

The study group comprised 160 patients. Of them, 13 were aged < 40 years at diagnosis. Mean age was 35 ± 3.9 years and 64.4 ± 11 years for the two groups. Among the younger patients, 38% were smokers (mean pack/day, 2.2) versus 71% in the older group (mean pack/day, 3). The younger group typically had a more advanced stage than the older group at presentation; eight young patients (62%) had stage III or IV versus 49 (33%) in the older group (P = .042). Mean overall survival was 6.7 ± 1 years for those under 40 years old and 7.7 ± 0.2 years for the older patients (P = .2). The 5-year survival rate was 69% for young patients and 90% for the older group (P = .04). However, there was no significant between-group difference in overall survival or 5-year survival rate when stratified for early- and late-stage disease.

Conclusions

There is a lower prevalence of classic risk factors in younger patient with laryngeal carcinoma in this study, suggesting a different etiology compared to our older cohort. The under-40 cohort presented with more advanced disease and had a worse 5-year survival; however, when stratified for early- versus late-stage disease, there was no significant difference in overall or 5-year survival between the groups. This may suggest that, despite a different etiology, laryngeal cancer behaves similarly in older and younger patients.

Level of Evidence

4 Laryngoscope, 2017

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Could laser-assisted dissection of the preepiglottic space affect functional outcome after ESL?

Objectives

To evaluate the effect of preepiglottic space (PES) dissection in the endoscopic supraglottic laryngectomy (ESL).

Study Design

A retrospective cohort study.

Methods

We retrospectively compared 15 patients who underwent ESL with 15 patients matched for clinical stage who underwent open partial horizontal laryngectomy (OPHL).

The functional outcomes were assessed in terms of hospital stay; need for nasal feeding tube (NFT) and tracheostomy, as well as duration of their use; postoperative complications; aspiration pneumonia rates; voice quality; and dysphagia.

Results

Among the ESL cases, combined dissection of the epiglottis and PES (type III) had a negative impact on functional outcomes. ESL patients experienced shorter hospital stays, as well as shorter use of NFT and tracheostomy, than patients who had OPHL.

Conclusion

Combined dissection of the epiglottis and PES (ESL type III) negatively affected functional outcome in patients undergoing ESL, a procedure generally related to significantly better functional outcomes than OPHL type I.

Level of Evidence

4. Laryngoscope, 2017

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Pacemaker failure as a cause of sudden death

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Multiple Actions of Phencyclidine and (+)MK-801 on Isolated Bovine Cerebral Arteries.

This study examines the direct effects of 3 noncompetitive N-methyl-D-aspartate receptor antagonists, phencyclidine (PCP), (+)MK-801, and (-)MK-801, on bovine middle cerebral arteries (BMCA). Rings of BMCA were mounted in isolated tissue chambers equipped with isometric tension transducers to obtain pharmacologic dose-response curves. In the absence of endogenous vasoconstrictors, the 3 N-methyl-D-aspartate antagonists each produced direct constriction of BMCA. The thromboxane A2 receptor antagonist SQ-29,548, the TxA2 synthase inhibitor furegrelate, the calcium antagonist nimodipine, and calcium-deficient media all inhibited maximal phencyclidine or (+)MK-801-induced constriction. Direct constriction by PCP or (+)MK-801 was independent of the presence of endothelium. When BMCA were preconstricted with potassium-depolarizing solution, PCP, (+)MK-801, and (-)MK-801 each produced only concentration-dependent relaxation. When BMCA were preconstricted with the stable TxA2 analog U-46,619 and exposed to increasing concentrations of PCP, (+)MK-801, or (-)MK-801, tension increased. Thromboxane A2 may contract BMCA by acting as a potassium channel blocker; iberiotoxin and tetraethylammonium both constrict BMCA. In Ca2+-deficient media containing either potassium or U-46,619, phencyclidine and (+)MK-801 each produced competitive inhibition of subsequent Ca2+-induced constriction. In additional experiments, arterial strips were mounted in isolated tissue chambers to directly measure calcium uptake, using 45Calcium as a radioactive tracer. Both phencyclidine and (+)MK-801 blocked potassium-stimulated or U-46,619-stimulated 45Ca uptake into arterial strips. These results suggest that phencyclidine and (+)MK-801 have 2 separate actions on BMCA. They may constrict arterial rings by releasing TxA2 from cerebrovascular smooth muscle, and relax arterial rings by acting as calcium antagonists. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial.

Background: Elderly patients have an increased risk of a stress response during extubation after general anesthesia. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress response and improve the quality of recovery in elderly patients after elective supratentorial craniotomy. Materials and Methods: In this prospective randomized controlled study, patients were randomly assigned to either a TEAS group (n=37) or a control group (n=38). The primary outcomes were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary outcome included the consumption of remifentanil and propofol, time to extubation and reorientation, extubation quality score, postoperative quality of recovery, and postoperative complications. Results: Compared with the control group, hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol during extubation were decreased in the TEAS group. TEAS reduced the consumption of remifentanil (P

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The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management During Awake Craniotomy.

Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Pneumothorax Following Rib Graft: An Atypical Presentation.

No abstract available

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Intraoperative Spinal Cord Pulsations: A Good Sign or a Disaster Waiting to Happen?.

No abstract available

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Radiographic Predictors of Difficult Laryngoscopy in Acromegaly Patients.

Background: Patients with acromegaly have a high risk of difficult laryngoscopy. However, clinical predictors, such as upper lip bite test or modified Mallampati class, show limited predictive performance for difficult laryngoscopy in such patients. In this retrospective study, we evaluated radiographic indices obtained from skull lateral x-ray and ostiomeatal unit computed tomography images to predict difficult laryngoscopy in acromegaly patients. Materials and Methods: Data on demographics, preoperative serum levels of pituitary hormones, and radiographic indices were collected from 90 acromegaly patients that underwent transsphenoidal removal for pituitary tumor from January 2010 to December 2016. Difficult laryngoscopy was defined as Cormack-Lehane grade >=III. Results: Difficult laryngoscopy occurred in 21 (23%) patients. In univariate analysis, age and radiographic indices indicating tongue size, such as tongue area (TA) on ostiomeatal unit computed tomography, linear distance from the alveolar line of the mandible to the hyoid bone, and linear distance from the interior border of the mandible to the hyoid bone on skull lateral x-ray, were associated with difficult laryngoscopy. In multivariate analysis, age (odds ratio [95% confidence interval], 1.084 [1.037-1.190]; P=0.002) and TA (1.002 [1.000-1.003], P=0.014) were independent risk factors for difficult laryngoscopy. The area under the curve of the combined model of age and TA was 0.80. Conclusions: Old age and radiographic predictors indicating large tongue size (large TA, long alveolar line of the mandible to the hyoid bone and mandible to the hyoid bone) were associated with an increased rate of difficult laryngoscopy in acromegaly patients. Preoperative radiographic measurements of tongue size can be helpful for safe airway management in such patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Prognostic role of neutrophil-to-lymphocyte ratio in head and neck cancer: A meta-analysis

Abstract

Background

Neutrophils play substantial roles in cancer progression. Previous reports demonstrated the prognostic impact of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in various types of solid cancers. The purpose of this study was to quantify the prognostic impact of NLR on head and neck squamous cell carcinoma (HNSCC).

Methods

We systematically searched electronic databases, identified articles regarding NLR and HNSCC mortality, and extracted hazard ratios (HRs) and 95% confidence intervals (CIs). Pooled HRs for overall survival (OS) and disease-specific survival (DSS) were estimated using random effect models.

Results

Nineteen studies enrolling 3770 patients were included in the analyses. Overall, NLR greater than the cutoff value was associated with poorer OS and DSS (HR 1.69; 95% CI 1.47-1.93; P < .001 and HR 1.88; 95% CI 1.20-2.95; P = .006, respectively).

Conclusion

Elevated NLR predicts worse outcomes in patients with HNSCC.

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Heterotopic thyroid autotransplantation: A preliminary clinical study

Abstract

Background

Thyroid autotransplantation offers an attractive alternative to subtotal thyroidectomy and replacement therapy. However, it has not been sufficiently clinically investigated.

Methods

Total thyroidectomy was performed for 20 patients with benign thyroid disorders, and at least 10 g of thyroid tissue were implanted intramuscularly. Graft monitoring was achieved through ^99mTc scan at 2 months, free triiodothyronine (FT3), FT4, and thyroid-stimulating hormone (TSH) measurements at 1, 2, 4, 6, 8, 10, and 12 months postoperatively, and clinical examination.

Results

Grafts survived and gradually functioned in all patients to a variable extent after a latent period (mean ^99mTc uptake = 1.28 ± 0.37%). Mean values for FT3, FT4, TSH at 12 months were 1.75 ± 0.48 pg/mL, 1.06 ± 0.26 ng/dL, and 28.08 ± 34.01 μIU/mL respectively.

Conclusion

Thyroid autotransplantation restored euthyroid status in 33.3% of patients after 12 months. A role of age, operative time, and ^99mTc-uptake in determining the final graft outcome is possible.

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AHNS Series: Do you know your guidelines? Review of current knowledge on laryngeal cancer

Abstract

The following article is part of a series in an initiative by the American Head and Neck Society's Education Committee and will review clinical practice guidelines for head and neck oncology. The primary goal is to increase awareness of current best practices pertaining to head and neck surgery and oncology. This manuscript is a review of current knowledge in laryngeal cancer with a focus on anatomy, epidemiology, diagnosis, evaluation, and treatment.

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